Heart Valve Patients May Benefit from Managing Own Blood Thinners

Benefits include lower risk of mortality after 5 years

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Chicago, 10 November 2015

Allowing
select patients to self-manage blood thinners following heart valve surgery may
lead to a lower risk of major complications, according to an article posted online by The
Annals of Thoracic Surgery.

Key Points:

Allowing patients to manage their own blood thinners may reduce the risk of major complications following heart valve surgery.

Patients were required to attend an educational program before gradually transitioning to self-management over the next 3 to 27 weeks.

After 5 years, patient self-management was associated with a lower risk of mortality compared to standard management.

Two kinds of heart
valves are available for patients undergoing valve replacement surgery.
Biological valves are made from animal tissue and have the potential to wear
out, especially in younger patients. Mechanical valves are made of metal and do
not wear out, but require anticoagulation therapy (blood thinners) to help
prevent blood clots, which could lead to strokes. The only anticoagulants
currently available to these patients are vitamin K antagonists, such as
warfarin or phenprocoumon.

“Oral
anticoagulation therapy is usually monitored by laboratory analysis of the
patient’s blood, which health care providers use to determine the appropriate
dosage of medication,” said Thomas Decker Christensen, MD, PhD, from Aarhus
University Hospital in Denmark, who led the study. “We believe that allowing
patients to have more control over their own treatment can improve the standard
of care in this patient group.”

Dr. Christensen
and colleagues evaluated the use of patient self-management of anticoagulation
therapy at two hospitals in Denmark between 1996 and 2012 and compared it to
the standard management. Their study included 615 patients with mechanical
heart valves who self-managed treatment and 3,075 control patients (a 5:1
ratio) who received standard treatment management following valve surgery.

Patients were
required to attend an educational program containing a minimum of three
teaching lessons in order to be eligible for self-management. Over a period of
27 weeks following the educational training, patients gradually became
self-managed.

“Once patients
were approved for self-management, they were allowed to continue as such but
could contact the treatment center with questions or concerns,” said Dr.
Christensen. “Patients were provided with a portable coagulometer, which they
used to analyze medication levels and monitor dosage. Blood levels were
measured and tracked weekly.”

Patients compared
their own measurements against the International Normalized Ratio, a number
that explains how quickly blood clots. Based on this ratio, patients adjusted
their dosage levels according to what they had been taught in the educational
training.

Researchers
observed low rates of adverse events among patients who transitioned to
self-management. At 1 year after treatment, the risk of major bleeding and
thromboembolism (a blood clot that moves through the bloodstream and blocks
another vessel) were similar in both treatment groups. After 5 years, however,
patients who self-managed their anticoagulants had a lower risk of all-cause
mortality compared to standard management patients.

“There are several
reasons that patients who self-manage treatment have better outcomes than those
who follow standard management,” explained Dr. Christensen. “Self-management
patients receive more detailed information about oral anticoagulation therapy;
they also learn more about the influence that diet, infectious diseases,
alcohol, and other drug interactions can have on their treatment than do
patients receiving standard management.”

He added that he
hopes this study will have an impact on the management and care of heart valve
patients, “We believe that the majority of patients who have a mechanical heart
valve inserted during surgery should be able to manage their oral anticoagulant
therapy, and recommend this as the standard treatment approach for these
patients.”

Note:
No authors reported disclosures specifically related to the data presented in
the present manuscript, but reported the following general conflicts: MM has
received speaker honoraria from Pfizer. ELG has received speaker honoraria from
AstraZeneca, Baxter, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb and
Pfizer and has participated in advisory board meetings for AstraZeneca, Bayer
and Bristol-Myers Squibb. TBL has served
as an investigator for Janssen Scientific Affairs, LLC and Boehringer Ingelheim
and has been on the speaker bureaus for Bayer, BMS/Pfizer, Roche Diagnostics,
Takeda and Boehringer Ingelheim. TDC has been on the speaker bureaus for
AstraZeneca, Boehringer Ingelheim, Pfizer, Takeda, Bristol-Myers Squibb and
Roche Diagnostics.

Full text of the article is
available to credentialed journalists upon request; contact Cassie McNulty cmcnulty@sts.org at +1 312 202 5865.

About The Annals of Thoracic
Surgery The Annals of Thoracic Surgeryis the official journal of STS and the Southern Thoracic Surgical
Association. Founded in 1964, The Society of Thoracic Surgeons is a
not-for-profit organization representing more than 6,800 cardiothoracic
surgeons, researchers, and allied health care professionals worldwide who are
dedicated to ensuring the best possible outcomes for surgeries of the heart,
lung, and esophagus, as well as other surgical procedures within the chest. The
Society’s mission is to enhance the ability of cardiothoracic surgeons to
provide the highest quality patient care through education, research, and
advocacy.

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